He is currently licensed as a physician, and is board certified in both general surgery and thoracic surgery. He has performed over 150 heart transplants and lung transplants, including pediatric heart transplants and combined heart and lung transplants.

In 1990, Frist met with former Senate Majority Leader Howard Baker about the possibilities of public office. Baker advised him to pursue the Senate, and in 1992 suggested that Frist begin preparations to run in 1994. Frist began to build support. He served on Tennessee's Governor's Medicaid Task Force from 1992 to 1993, joined the National Steering Committee of the Republican National Committee's Health Care Coalition, and was deputy director of the Tennessee Bush-Quayle 1992 campaign.

During the 1994 election, Frist promised not to serve for more than two terms, a promise he honored.[5]

He accused his opponent, incumbent Senator Jim Sasser, of "sending Tennessee money to Washington, DC", and said, "While I've been transplanting lungs and hearts to heal Tennesseans, Jim Sasser has been transplanting Tennesseans' wallets to Washington, home of Marion Barry." During the campaign he also criticized Sasser for trying to become Senate Majority Leader, claiming that his opponent would be spending more time taking care of Senate business than Tennessee business. Frist won the election, defeating Sasser by 13 points in the 1994 Republican sweep of both Houses of Congress, thus becoming the first physician in the Senate since June 17, 1938, when Royal S. Copeland died.[citation needed]

In his 2000 reelection campaign, Frist easily won with 66 percent of the vote. He received the largest vote total ever by a statewide candidate. Frist's 2000 campaign organization was later fined by the Federal Election Commission for failing to disclose a $1.44 million loan taken out jointly with the 1994 campaign organization.[6]

In the aftermath, Lott resigned his position as Senate Majority Leader and Frist was chosen unanimously by Senate Republicans as his replacement. He became the third youngest Senate Majority Leader in US history. In his 2005 book, Herding Cats, A Lifetime in Politics, Lott accuses Frist of being "one of the main manipulators" in the debate that ended Lott's leadership in the Republican Senate. Lott wrote that Frist's actions amounted to a "personal betrayal". Frist "... didn't even have the courtesy to call and tell me personally that he was going to run ... If Frist had not announced exactly when he did, as the fire was about to burn out, I would still be majority leader of the Senate today," Lott wrote.[citation needed]

In the 2003 legislative session, Frist enjoyed many successes. He was able to push many initiatives through to fruition, including the Bush administration's third major tax cut and legislation that was against partial-birth abortion. However, the tactics that he used to achieve those victories alienated many Democrats. He also was instrumental in developing and then passing the President's Emergency Plan for AIDS Relief (PEPFAR), the historic and unprecedented funding commitment to fight disease. In 2004, by comparison, he saw no major legislative successes, with the explanations ranging from delay tactics by Democrats to lack of unity within the Republican Party.[citation needed]

In a prominent and nationally broadcast speech to the Republican National Convention in August 2004, Frist highlighted his background as a doctor and focused on several issues related to health care. He spoke in favor of the recently passed Medicare prescription drug benefit and the passage of legislation providing for Health Savings Accounts. He described President Bush's policy regarding stem cell research, limiting embryonic stems cells to certain existing lines, as "ethical".

In an impassioned argument for medical malpractice tort reform, Frist called personal injury trial lawyers "predators": "We must stop them from twisting American medicine into a litigation lottery where they hit the jackpot and every patient ends up paying." Frist has been an advocate for imposing caps on the amount of money courts can award plaintiffs for noneconomic damages in medical malpractice cases.[7]

During the 2004 election season, Frist employed the unprecedented political tactic of going to the home state of the opposition party's minority leader, Democrat Tom Daschle of South Dakota, and actively campaigning against him. Daschle's Republican opponent, John Thune, defeated Daschle. In Daschle's farewell address, Frist arrived late. The two men have since found common ground and work together at the Bipartisan Policy Center and often speak together for healthcare conventions and events.[8] After the 2004 elections, amid the controversy over Arlen Specter's post-election remarks, [clarification needed] Frist demanded a public statement from Specter to repudiate his earlier remarks and pledge support for Bush's judiciary nominees. Frist rejected an early version of the statement as too weak, and gave his approval to the statement that Specter eventually delivered.[citation needed]

Many of Frist's opponents have attacked him for what they see as pandering to future Republican primary voters. They claim he has taken extreme positions on social issues such as the Terri Schiavo case to please them. However, Frist changed his position on stem cell research. Frist received enormous praise from former First Lady Nancy Reagan for supporting expanded federal financing for stem cell research.[9]

There has also been controversy regarding the "nuclear option", under which the Republicans would change a rule in the Senate to prevent the filibuster of judicial nominations. Although Frist claimed that "[n]ever before has a minority blocked a judicial nominee that has majority support for an up-or-down vote on the Senate floor", critics pointed to the nearly two-century history of the filibuster, including the successful four-day 1968 minority Republican filibuster of Lyndon Baines Johnson's chief justice nominee, Abe Fortas.[10][11]

In 1998, Frist participated in the Republican filibuster to stall the nomination of openly gay James C. Hormel to be ambassador to Luxembourg; Hormel eventually received a recess appointment from President Bill Clinton, bypassing a Senate vote. Frist also helped block the 1996 nomination of Richard Paez to the 9th Federal Court of Appeals, a four-year filibuster that was defeated in 2000 when 14 Republicans dropped their support for it and allowed Paez to be confirmed by a simple majority.[citation needed]

More criticism of perceived weakness came in the midst of an extended confirmation fight over Bush's pick for US ambassador to the United Nations, John R. Bolton. Twice Frist failed to garner the 60 votes to break cloture, getting fewer votes the second time and even losing the support of one moderate Republican (George Voinovich of Ohio). On June 21, 2005, Frist said the situation had been "exhausted" and there would be no more votes. Only an hour later, after speaking to the White House, Frist said: "The president made it very clear he wants an up-or-down vote." This sudden switch in strategy led to charges of flip-flopping in response to pressure from the Bush administration. Nevertheless, no up-and-down vote was held, and Bush made a recess appointment of Bolton.[citation needed]

In September 2006, working with Arizona Senator Jon Kyl, Frist was a major Senate supporter of H.R. 4411 — the Unlawful Internet Gambling Enforcement Act of 2006. Frist's bill called for restrictions on banking transactions for online gambling, while Frist has received contributions from land-based casinos. The bill, which passed without debate as part of the SAFE Port Act, also allowed horse racing and lotteries to remain legal.[citation needed]

Frist pledged to leave the Senate after two terms in 2006, and did not run in the 2006 Republican primary for his Senate seat. He campaigned heavily for Republican candidate Bob Corker, who won by a small margin over Congressman Harold Ford, Jr. in the general election.

Frist was seen as a potential presidential candidate for the Republican party in 2008, like Bob Dole, a previous holder of the Senate Majority Leader position. On November 28, 2006, however, he announced that he had decided not to run, and would return to the field of medicine.[12]

Frist's name was mentioned as a possible candidate for Governor of Tennessee in 2010 when incumbent Governor Phil Bredesen was barred from running again due to term limits. Tennessee Republican Party Chairman Bob Davis has said that "he'd have a lot of support" if he chose to run.[13] Frist announced that he had decided not to seek that office in January 2009.

After leaving the U.S. Senate, he became a Co-Chair of ONE VOTE '08, an initiative of the ONE campaign, with Former Senate Majority Leader Tom Daschle (D-SD). According to onevote.org, "ONE Vote '08 is an unprecedented, non-partisan campaign to make global health and extreme poverty foreign policy priorities in the 2008 presidential election."[14] He traveled to Africa in support of various initiatives for the ONE campaign in July 2008 and an extensive blog about his trip exists, complete with videos here.

In 2009, Frist launched a statewide education reform nonprofit organization targeting K-12 education called SCORE (State Collaborative on Reforming Education).[15] The organization's mission is to "collaboratively support Tennessee's work to prepare students for college and the workforce." Frist serves as the Chairman of SCORE's Board of Directors.

As part of SCORE's work, Frist presents the State of Education in Tennessee report at the beginning of each year, a comprehensive look at the state's efforts to improve public education.[16] SCORE also awards the SCORE Prize on an annual basis, which is given annually to the elementary, middle, and high school in Tennessee, along with one school district, that have most dramatically improved student achievement.

In addition to Senator Frist's decades of medical mission work and commitments to other global health organizations, his main thrust in global health is via his Nashville-based Hope Through Healing Hands (HTHH), a nonprofit 501(c) 3 whose mission is to promote improved quality of life for citizens and communities around the world using health as a currency for peace. Jenny Eaton Dyer, Ph.D. has served as CEO/Executive Director since 2008.

Under the umbrella of health diplomacy, HTHH includes efforts for child survival/maternal health, clean water, extreme poverty, and global disease such as HIV/AIDS, tuberculosis, and Malaria. Strategically, HTHH promotes global partnership by working hand-in-hand with leading organizations that best address these issues in developing nations.

Since 2004 HTHH has invested more than $3.5 million in charities in both the United States and abroad. These investments have been in support of infrastructure, sustainable health development, education, healthcare, and emergency relief.

HTHH's flagship program is the Frist Global Health Leaders program. This program sponsors young health professionals as students and residents to travel to underserved areas to promote peace through health in communities and clinical settings. These students spend between one-three month(s) focusing on service to those in need, alongside the work of training community health workers.

In June 1989, Frist published his first book, Transplant: A Heart Surgeon's Account of the Life-And-Death Dramas of the New Medicine, in which he wrote, "A doctor is a man whose job justifies everything . . . Life [is] a gift, not an inalienable right."

With J. H. Helderman, he edited "Grand Rounds in Transplantation" in 1995. In October 1999, Frist co-authored Tennessee Senators, 1911–2001: Portraits of Leadership in a Century of Change with J. Lee Annis, Jr. In March 2002, Frist published his third book, When Every Moment Counts: What You Need to Know About Bioterrorism from the Senate's Only Doctor. While generally well received, the book later spurred accusations of hypocrisy regarding his remarks about Richard Clarke. When Clarke published his book Against All Enemies in 2004, Frist stated "I am troubled that someone would sell a book, trading on their service as a government insider with access to our nation's most valuable intelligence, in order to profit from the suffering that this nation endured on September 11, 2001." In December 2003, Frist and co-author Shirley Wilson released the self-promoting book, Good People Beget Good People: A Genealogy of the Frist Family.

In 2008, he became a partner in Chicago-based Cressey & Co. investing in the nation's health care market.[21][22] In 2009, Frist began teaching at Vanderbilt's Owen School of Management and at the Medical School[20] where he taught before his 1994 election, while becoming a chairman of the Nashville-based nonprofit organization Hope Through Healing Hands that centers on health and education around the world.[23] He is currently adjunct professor of Surgery in the Department of Cardiac Surgery at Vanderbilt and clinical professor of Surgery at Meharry Medical College.[24]

In May 2009, Frist joined forensic chemical and drug-testing laboratory Aegis Sciences Corp. as a health care advisor and member of its board of directors. His new responsibilities include assisting in Aegis's development of a strategic alliance with Vanderbilt University Medical Center, providing counsel on the company's research and development for new laboratory-based toxicology assessments, and advise Aegis on general health care issues.[25]

In November 2009, Frist joined the board of directors of engineering, construction and technical services firm URS Corp. to bring his expertise and unique perspective on a wide range of economic issues.[26][27]

In March 2010, Frist was appointed a member of the six-person board of the Clinton Bush Haiti Fund, which had raised $66 million to date for immediate earthquake relief and long-term recovery efforts in the Caribbean country.[28] Frist had also traveled to Haiti with Samaritan's Purse in January 2010 and with the Clinton Bush Haiti Fund in June 2012.[20]

In July 2012, the Robert Wood Johnson Foundation (RWJF) announced that Frist had been elected to its Board of Trustees, effective in January 2013.[30] RWJF is the largest health-oriented foundation in the United States. His other board service includes First Lady Michelle Obama's "Partnership for a Healthier America" campaign to eliminate childhood obesity within a generation,[31] the Kaiser Family Foundation, the Smithsonian Museum of Natural History, the Center for Strategic and International Studies, Harvard Medical School Board of Fellows, and the Advisory Committees for Global Health at Duke and Harvard. He is also on the advisory board for technologically innovative healthcare companies ZocDoc and aTherapy.[32]

Frist also leads medical mission trips to recent disaster sites around the globe, including New Orleans after Hurricane Katrina, Sri Lanka after the 2004 Indian Ocean tsunami, and Haiti after the devastating 2010 earthquake.

In 1982, Frist married Karyn McLaughlin. Frist recounted in his 2009 memoir meeting his future wife in 1979 when he attended to at a clinic in Boston. He was engaged to another woman in Tennessee and broke it off a week before the wedding. They have three sons: Harrison, Jonathan, and Bryan. The Frist family were members of the National Presbyterian Church in Washington, D.C.. Karyn Frist reportedly filed for divorce on September 7, 2012.[36]

Frist has a fortune in the millions of dollars, most of it the result of his ownership of stock in Hospital Corporation of America, the for-profit hospital chain founded by his brother and father. Frist's 2005 financial disclosure form lists blind trusts valued between $15 million and $45 million.[39]

Members of the Frist family have been major donors to Princeton University, pledging a reported $25 million in 1997 for the construction of the Frist Campus Center.[40] Frist has said that, a few years after his 1974 graduation from Princeton, "I made a commitment to myself that if I was ever in a position to help pull together the resources to establish a center [on the Princeton campus] where there could be an informal exchange of ideas, and to establish an environment that is conducive to the casual exchange of information, I would do so."[41]Daniel Golden, a Wall Street Journal journalist and author of the book The Price of Admission: How America's Ruling Class Buys Its Way into Elite Colleges — and Who Gets Left Outside the Gates, has suggested that two of Frist's sons (Harrison and Bryan) were admitted to Princeton as recognition of this donation rather than their own academic and extracurricular merit.[42]

Bill and Karyn Frist are the sole trustees in charge of a family foundation bearing the senator's name, which had more than $2 million in assets in 2004. He and his siblings are vice presidents of another charitable foundation bearing their parents' names. Frist failed to list his positions with the two foundations on his Senate disclosure form. In July 2006, when the matter was raised by the Associated Press, his staff said the form would be amended. Frist has previously disclosed his board position with World of Hope, a charity that gives money to causes associated with AIDS. The charity has come under scrutiny for paying consulting fees to members of Frist's political inner circle.[43]

The status of Frist's blind trust, and subsequent statements about it and activities within it led to an SEC Investigations of the trustees June 13, 2005 sale. The U.S. Attorney for the Southern District of New York issued subpoenas to investigate the sale, and the U.S. Securities and Exchange Commission began an insider trading investigation of the sale. After an 18-month investigation, the SEC closed its probe without pressing charges. Frist said in a statement, "I've always conducted myself according to the highest ethical standards in both my personal and public life, and my family and I are pleased that this matter has been resolved." [44]

Just before Congress adjourned for the 2006 elections, in what politicos call a "midnight drop", Frist inserted the Unlawful Internet Gambling Enforcement Act (UIGEA) clauses into the larger, unrelated Security and Accountability for Every Port (SAFE) Act. The SAFE Act itself was a late "must pass" bill designed to safeguard ports from terrorist infiltration.[45] In the Zogby International Poll, 87% believe online gambling is a personal choice which should not be banned. A Wall Street Journal Poll showed 85% oppose government prohibition of online gambling.[46] The UIGEA became the basis for the April 15, 2011, US Department of Justice government crackdown and domain name seizure of three of the worlds top online poker sites, dubbed "black Friday" in the poker community.[47][48] The DOJ Office of Legal Counsel subsequently issued an opinion in September 2011, stating that the UIGEA applies only to betting on sporting events and contests and not to other types of online gambling.[49][50][51][52]

The Federal Election Commission (FEC) found that Frist's 2000 Senate campaign committee, Frist 2000, Inc., violated federal campaign finance laws. "In June 2000, Senator Frist took $1 million of the money that had been contributed to his 2000 Senate campaign and invested it in the stock market, where it promptly began losing money. In November 2000, Senator Frist sought to collect $1.2 million he had lent his 1994 Senate campaign committee. As a result of the stock market losses, however, Frist 2000, Inc. did not have enough money to repay the loan. Senator Frist solved this problem by having the 1994 and the 2000 campaign committees jointly take out a $1.44 million bank loan at a cost of $10,000 a month interest. Frist 2000, Inc. did not report this debt on its FEC disclosure forms."[53] Frist paid a civil fine of $11,000 in a settlement with the FEC.

In the Terri Schiavo case, a brain-damaged woman whose husband wanted to remove her gastric feeding tube, Frist opposed the removal and in a speech delivered on the Senate Floor, challenged the diagnosis of Schiavo's physicians of Schiavo being in a persistent vegetative state (PVS): "I question it based on a review of the video footage which I spent an hour or so looking at last night in my office".[57] Frist was criticized by a medical ethicist at Northwestern University for making a diagnosis without personally examining the patient and for questioning the diagnosis when he was not a neurologist.[58] After her death, the autopsy showed signs of long-term and irreversible damage to a brain consistent with PVS.[59] Frist defended his actions after the autopsy.[60]

While he was a medical school student in the 1970s, Frist performed fatal medical experiments and vivisection on shelter cats while researching the use of drugs on the mitral valve. By his own account, Frist improperly obtained these cats from Boston animal shelters, falsely telling shelter staff he was adopting the cats as pets.[61] In his book, Frist asserted that he succumbed to the pressure to succeed in a highly competitive medical school.

Frist's treatment of cats first became controversial in 1994, in his first Senate campaign, when the opposing camp in the Republican primary called him a cat-killer. The matter again created public controversy in 2002, after mention in a Boston Globe profile, published after his election as Senate majority leader.[62][63]

Frist's primary legislative focus has been on issues of concern to the health care industry and on pro-life issues. He also opposes abortion and all federal funding of abortion. In the Senate, he led the fight against partial birth abortion, voted for the Partial-Birth Abortion Ban Act of 2003 and against an amendment to include a woman's health exception (saying that he considered the procedure to be hazardous to a woman's health).[64]

Frist supported a total ban on human cloning, including for embryonic stem cell research. Since 2001, Frist had stood beside Bush in his insistence that only currently existing lines be used for stem cell research. But in July 2005, after severely criticizing the MLO, Frist reversed course and endorsed a House-passed plan to expand federal funding of the research, saying "it's not just a matter of faith, it's a matter of science."[65] Up to that point the legislation had been considered bottled up in the Senate. The decision quickly drew criticism from some Christian groups such as James Dobson, but garnered praise from some Democrats and many Republicans, including former First Lady Nancy Reagan.

On education, Frist supports the No Child Left Behind Act, which passed in 2001 with bipartisan support. In August 2005, he announced his support for teaching intelligent design in public school science classes.

In November 2005, Frist told reporters that he was less concerned about possible torture at CIA secret prisons than he was about potentially compromising the security of millions of Americans. Flying home after visiting the Guantanamo Bay detention center he said September 10, 2006 he expects bipartisan support for putting top captured al-Qaeda figures on trial before military commissions and for guidelines on how they should be treated. Frist visited the detention center in eastern Cuba, which holds some 460 detainees, including 14 top alleged al-Qaida figures recently transferred from CIA custody. He stated that his visit with fellow Republicans Sen. Mitch McConnell of Kentucky and Sen. Arlen Specter of Pennsylvania, the Senate Judiciary Committee chairman, was especially poignant coming one day short of the fifth anniversary of the attacks that killed nearly 3,000 people. Frist said that visiting the Guantanamo Bay Detention Center, and recognizing that the 14 individuals who likely contributed to the September 11, 2001 attacks were there, led him to realize how critical it is that the U.S. define the appropriate criteria to make sure that the government have the information to prevent such a tragedy from occurring again. The senators didn't see the 14 new detainees, but visited Guantanamo to learn of the interrogation techniques. In his mind, the detainees are being treated in a safe and humane way.

After leaving the Senate, during the health care reform debates, Frist stated that he would have broken with his party and would have voted in favor of the Patient Protection and Affordable Care Act, which was unanimously voted against by Republicans.[67] In January 2011, after the Republicans regained a majority in the House, Frist called on them not to attempt to repeal the health care law.[68]